Journal Article

Detection of Residual Pulmonary Vascular Obstruction by Ventilation-Perfusion Lung Scan Late After a First Pulmonary Embolism

Ecarnot, Fiona, Meneveau, Nicolas, Chatot, Marion, Didier-Petit, Katy, Genet, Bruno, Hyvert, Agnes, Chopard, Romain, Napporn, Gabriel, Schiele, Francois

2017

Overview

The long-term impact of persistent pulmonary vascular obstruction after pulmonary embolism (PE) remains unknown. Based on ventilation-perfusion lung scan performed at discharge and 3 months after a first PE, we aimed to investigate the prognostic value on 5-year adverse events of (1) residual pulmonary vascular obstruction (RPVO) at discharge (DIS-RPVO), (2) RPVO at 3 months (3M-RPVO), and (3) relative change in RPVO between the 2 scans (RC-RPVO). We performed a prospective, multicenter cohort study from January 2007 to December 2009 including patients who survived at least 3 months after a PE. RC-RPVO was defined as (DIS-RPVO − 3M-RPVO)/DIS-RPVO. The primary end point was a combined end point at 5 years, composed of all-cause death, recurrent venous thromboembolism, chronic thromboembolic pulmonary hypertension, heart failure, and rehospitalization for cardiac causes. Receiver-operating characteristic curves were computed to define thresholds of DIS-RPVO, 3M-RPVO, and RC-RPVO predictive of the primary combined end point at 5 years. Overall, 241 patients were included (high-risk PE: 11.2%, intermediate-risk PE: 51.8%, low-risk PE: 37%). Mean DIS-RPVO was 27.9 ± 15.1%, mean 3M-RPVO was 10.3 ± 10.8%, and mean RC-RPVO was 61.7 ± 33.4%. At 5 years, 112 patients (46.5%) experienced the combined end point. Both 3M-RPVO ≥15% and RC-RPVO ≤37.5% were independently related to the occurrence of the combined end point at 5 years (p = 0.01 and p = 0.02, respectively). DIS-RPVO did not predict long-term adverse events. In conclusion, RC-RPVO ≤37.5% and 3M-RPVO ≥15% were independently related to the occurrence of adverse events 5 years after a first PE.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Aged / Anticoagulants / Arterial Occlusive Diseases - diagnosis / Arterial Occlusive Diseases - epidemiology / Arterial Occlusive Diseases - etiology / Cardiovascular / Computed Tomography Angiography / Discharge / Dyspnea / Embolism / Embolisms / Female / Follow-Up Studies / France - epidemiology / Health risk assessment / Heart / Heart diseases / Hospitals / Humans / Hypertension / Lung - diagnostic imaging / Lungs / Male / Medical imaging / Morbidity - trends / Mortality / Patients / Perfusion / Prognosis / Prospective Studies / Pulmonary arteries / Pulmonary Artery / Pulmonary Embolism - complications / Pulmonary Embolism - diagnosis / Pulmonary Embolism - mortality / Pulmonary embolisms / Risk / Survival Rate - trends / Thresholds / Thromboembolism / Thrombosis / Time Factors / Ventilation